Motor Skills
Motor skills or coordination is the product of a complex set of cognitive and physical processes. Smooth, targeted, and accurate movements, both gross and fine, require the harmonious functioning of sensory input, central processing of the information in the brain and coordination with the high executive cerebral functions, such as volition, motivation, motor planning of an activity. The performance of a certain motor pattern is also important. All of these elements must work in a coordinated and rapid way to enable complex movements involving different parts of the body.

Motor Skill

Gross motor skills

Includes lifting one's head, rolling over, sitting up, balancing, crawling, and walking. Gross motor development usually follows a pattern. Generally large muscles develop before smaller ones, thus, gross motor development is the foundation for developing skills in other areas like fine motor skills. Development generally moves from the top of the body down to the bottom.

Fine motor skills

Includes the ability to manipulate small objects, transfer objects from hand to hand, and various hand-eye coordination tasks. Fine motor skills may involve the use of very precise motor movement in order to achieve an especially delicate task. Some examples of fine motor skills are using the pincer grasp using the thumb and forefinger to pick up small objects, cutting, coloring, or writing. Fine motor development refers to the development of skills involving the smaller muscle groups.

Ambidexterity

Is a specialized skill in which there is no dominance between body symmetries, so tasks requiring fine motor skills can be performed with the left or right extremities. The most common example of ambidexterity is the ability to write with the left or right hand, rather than one dominant side.

Motor skill dysfunction has many causes, such as the demyelination of motor neurons. While fatigue or weariness may lead to temporary short-term deterioration of fine motor skills observed as visible shaking, serious nervous disorders may result in a loss of both gross and fine motor skills due to the hampering of muscular control.
Motor Symptoms
Motor symptoms have to deal with the muscular movement of any part of the body. This movement refers to something that produces or refers to motion. An example being a motor neuron is a nerve cell that conveys an impulse to a muscle causing it to contract. Multiple sclerosis (MS) motor symptoms typically involve weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, or a lack of coordination. It's associated with muscle tightness and weakness that limit a limb's range of movements.

Muscle-related symptoms most often occur in the arms and legs and at times, these symptoms may impair walking. Spasticity, which is the involuntary tightening of a muscle, can manifest as stiffness, pain or spasms. Some may experience an intention tremor causing difficulty in making small or complex movements and notice their hands shake when trying to pick something up, write, or button their shirt.

Muscle-Related Symptoms may include:
Loss of balance
Numbness or abnormal sensation in any area
Pain because of muscle spasms
Pain in the arms or legs
Problems moving arms or legs
Problems walking
Problems with coordination and making small movements
Slurred or difficult-to-understand speech
Tremor in one or more arms or legs
Uncontrollable spasm of muscle groups (muscle spasticity)
Weakness in one or more arms or legs
Loss of Mobility and Spasticity
Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with movement, speech, and manner of walking. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement.

Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs), and fixed joints. The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. Spasticity can interfere with rehabilitation in patients with certain disorders, and often interferes with daily activities.

Almost everyone with MS will have some loss of mobility, which may take the form of impaired (lessened) motor control, muscle weakness, impaired balance, and spasticity. Spasticity is one of the primary symptoms of MS and is characterized by weakness, loss of dexterity, and the inability to control specific movements. It's usually more severe in the legs and torso. Mobility can also be affected by many non-physical factors including mental well-being, social networks, fatigue, and even the weather.

In the case of MS, spasticity is due to nerve conduction being interrupted by a lesion located in the brain or spinal cord. It can be present at any point of the disease (early or late onset) and the symptoms can vary from mild to severe. In severe cases, spasticity can even cause a limb to become "frozen" in a bent position, requiring immediate medical attention.

Spasticity can be complicated by dystonia where the problem is not only increased muscle tone but odd postures such as neck twisting to one side or the other. Dystonia can also exist alone as an isolated movement disorder in MS. One or more muscles or muscle groups can be involved in spasticity or dystonia. Muscle spasticity, or excessive tightness, is common and may be more disabling than weakness.

Spasticity occurs as a result of an imbalance between the excitatory and inhibitory signals from the brain and/or spinal cord. Excitatory signals send messages to other neurons, firing them into action, whereas inhibitory signals stop neurons firing and suppress a response, such as stopping a full bladder from spontaneously emptying itself. It's thought that there is an interruption of the inhibitory signals along the spinal cord and in the brain which results in an increased excitation and therefore an imbalance.

Spasticity affects body functions and can cause activity limitations and participation restrictions, primarily due to its effect on functional movement.

Detrimental Consequences Associated with Spasticity:
Interference with mobility, ability to exercise and the range of motion in joints
Negative impact on endurance and energy expenditure
Interference with the activities of daily living
Discomfort or pain
Sleep disturbance

Those who have severe pain or spasticity may benefit from having a catheter or pump placed in the lower spinal area to deliver a constant flow of medication, such as baclofen if oral medications fail.

It's important to approach spasticity management from an interdisciplinary team approach with everyone involved so they can better identify goals and make the adjustments necessary to attain optimal spasticity management. Goals of spasticity management should be orientated towards the improvement of function and improved comfort, and an individual's response to interventions such as medications, rehabilitation or surgery needs to be closely monitored.

Positioning

It's important that the person with spasticity is positioned correctly when sitting and lying down to prevent limbs becoming fixed in an inappropriate position. They should be able to lie flat every day in order to stretch the muscles involved. Lying on the side and standing are also useful for stretching muscles in spasm. Posture when sitting needs to be well balanced and stable. Special seating systems are available to help with this. The person should be moved regularly to avoid damage to skin and help in joint mobility. Design of the wheelchair is also important, as it's essential that it provides support for the upper body and limbs.
Loss of Strength / Weakness
Many of those with MS lose muscle strength in the arms and legs as the disease progresses. Muscle weakness can involve the extremities (arms and legs) on one side of the body (hemiparesis), both legs (paraparesis), or all four extremities (quadraparesis). Muscles in the affected area may tighten (spasticity) and contract spontaneously (spasm or clonus). The loss can range from reduced dexterity to paralysis of an arm or leg. The loss of muscle strength occurs not only in the for of relapses, but also as a gradual process without recovery. Depending on the severity, an assistive devise may be required.

Respiration

Respiration or breathing is primarily under the control of the autonomic nervous system (ANS) which is the part of the central nervous system (CNS) that controls vital functions such as heartbeat and respiration without conscious thought. It's unusual for MS to affect the ANS and therefore uncommon for breathing problems to occur in MS as a direct result of loss of autonomic control. If breathing problems occur suddenly, it's imperative to see your doctor immediately or go to the emergency room since this may indicate infection or some other problem.

Weakness of the ventilatory muscles can begin early in the disease. In MS, the most common cause of respiratory problems is loss of muscle strength and endurance. Just as a person can experience muscle weakness in the arms or legs, weakness can occur in the ventilatory muscles of the chest and abdomen that are involved in breathing. Just like weakness in the other parts of the body, weakness of the ventilatory muscles can begin to occur early in the disease course and gradually worsen over time.

Certain medications may also contribute to respiratory problems such as tranquilizers, muscle relaxants, and opioid analgesics, can depress breathing. The use of these medications should be carefully monitored in anyone with a history of respiratory distress or swallowing problems.

Respiratory changes can also contribute to other problems. People with weakened ventilatory muscles have to work harder to inhale and exhale. This extra effort can be quite tiring, particularly for people who already experience a significant amount of MS fatigue. Respiratory problems can also interfere with the process of speech and voice production making it much more difficult and tiring for people to carry on a conversation or speak loudly enough to be heard.
Seizures
Seizures, which are the result of abnormal or excessive electrical discharges in an injured or scarred area of the brain (usually in the cerebral cortex), are fairly uncommon among those with MS. The incidence of seizures has been estimated at 2 to 5%, compared to the estimated 1% incidence of seizures in the general population.

Seizures in those with MS tend to be mild and cause no permanent damage. The vast majority of people with MS can control or eliminate their seizures with anti-seizure medication, and many people don't have to take any medications at all. There are, however, a small percentage that may have seizures that don't respond to medication at all.

Several Forms of Seizures:
Several Forms of Seizures
Generalized tonic-clonic seizures are brief episodes of unconsciousness with uncontrollable jerking movement of extremities.
Generalized absence seizures are momentary lapses of consciousness without abnormal movements.
Partial complex seizures are periods of repetitive activity, the person appears to be awake but doesn't respond to external stimuli.

Tonic-Clonic Seizures

Tonic-clonic seizures are sometimes referred to as "grand mal" seizures, although this term is becoming less commonly used. Although they look very dramatic and scary to observers, people experiencing tonic-clonic seizures don’t really feel them as they are happening. They may experience different warning sensations, known as auras. These can include a sudden feeling of anxiety, the sense that everything is fuzzy or dreamlike or a strange smell or taste. The person will typically feel very tired and washed-out after experiencing a seizure.

The 2 Phases of Tonic-Clonic Seizures:
Tonic The person loses consciousness, the muscles stiffen and the person falls down. The muscles remain rigid and stiff for a short time.
Clonic The stage when convulsions (rhythmic flexing and relaxing of the muscles) occur, usually lasting less than two minutes.

Simple or Complex Partial Seizures

Simple Partial Seizures - While these seizures don't cause the person to lose consciousness, they do make things seem "different" or "off." For example, people may experience strange emotions, or the way things look, sound, feel, smell or taste may be altered. In some cases, the person’s muscles may stiffen up or start twitching, usually just in one side of the face or body.

Complex Partial Seizures - These seizures also don't cause a loss of consciousness, meaning people don't "pass out" if they have one. However, this type of seizure does result in a loss of awareness for a short amount of time. People won't remember what happened during this time, nor will they be able to respond to anyone. People having complex partial seizures often stare or move in repetitive ways like rubbing their hands, swallowing or making sounds.

Paroxysmal Symptoms of MS Differ from Seizures

Paroxysmal symptoms in MS are brief sudden attacks of abnormal posturing of the extremities, loss of tone in the legs (drop attacks) or other manifestations that may appear similar to an epileptic seizure but are of different origin. Examples of paroxysmal symptoms include: paroxysmal pain (trigeminal neuralgia); tonic spasms of an arm or leg; Lhermitte's sign; Uhthoff's symptoms (transient blurring of vision associate with exertion and elevated body temperature).